News from Annals of Internal Medicine tip sheet -- June 10, 2014

Efforts to prevent invasive cervical cancer should focus on increasing screening rates, regardless of which test is used, according to a commentary being published in Annals of Internal Medicine. Each year, approximately 12,000 women in the United States will be diagnosed with cervical cancer. Nearly all cases of cervical cancer are caused by the human papilloma virus, or HPV. Screening tests for cervical cancer are intended to detect cancer at its earliest stages when death or impairment can be prevented. To be effective, screening tests should have high sensitivity (able to detect most disease), and acceptable specificity (relatively low false-positive rate). Current guidelines recommend routine cotesting for cervical cancer with an HPV test and Pap smear every five years or Pap smear testing alone every three years. In April, the U.S. Food and Drug Administration approved the Cobas HPV test to be used alone to screen women aged 25 years and older for cervical cancer. The authors of a new commentary suggest that this switch in paradigm from Pap testing to HPV testing raises many questions about which test, or combination, is most effective, cost-effective, and would result in the least repeat testing. The authors argue that most cervical cancer occurs in women who have not had any recent screening. Therefore, increasing population coverage with any screening test as well as ensuring that women are not lost to follow-up with lengthy screening intervals is more important than the choice of test.

Note: The URL will go live at 5:00 p.m. on Monday, June 9 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To interview the lead author, please contact Gina Digravio at gina.digravio@bmc.org or 617-638-8480.

2. Experts explain merits and shortcomings of Medicare data release

Two new commentaries in Annals of Internal Medicine discuss the significance of data released in April by the Centers for Medicare and Medicaid Services (CMS) on $77 million in physician billings to Medicare Part B, which covers services delivered to seniors and the disabled. Data on the treatments performed and payments made to more than 880,000 health care providers was released to the public in response to a Freedom of Information request made by the Wall Street Journal.

In the first commentary, Gail R. Wilensky, Ph.D., senior fellow at project HOPE and a former administrator for CMS, writes that the data released may be helpful in identifying fraud cases and can also further understanding of variation in health care and spending. However, Dr. Wilensky points out that missing data may lead to misinterpretation. For example, data on physician procedure volume that could help patients determine which doctors may be best for treating their medical conditions is incomplete because it does not include procedures covered by Medicaid or private insurers. In addition, the data is void of any quality metrics. Despite concerns in the medical community, Dr. Wilensky concludes that transparency in pricing and quality and health care is here to stay and suggests that physicians groups take the initiative to develop useful and accurate ways to report information.

In the second commentary, Eric M. Horwitz, MD, and David S. Weinberg, MD, MSc from the Departments of Radiation Oncology and Medicine at Fox Chase Cancer Center in Philadelphia express concern about the data released by CMS because they say it lacks meaningful context. Therefore, the authors caution against evaluating the data without a deeper understanding of what the data can and cannot reveal. For example, the figures provided by CMS do not explain how physicians made treatment decisions, the number of patients seen outside of Medicare, drug costs, lab services used, etc. One thing the figures do reveal is a huge regional variation in costs of care. The authors suggest that these Medicare data are an important step towards the transparency needed to enable thoughtful analyses of variations in health care and its costs but caution that careless evaluation of the data will hinder, not promote, efforts to improve health care value.

Note: The URL will go live at 5:00 p.m. on Monday, June 9 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To interview Dr. Wilensky, please contact Gloria Burrell at gburrell@projecthope.org or 301-347-3903. To interview Dr. Horwitz, please contact Diana Quattrone at Diana.Quattrone@fccc.edu or 215-728-7784.

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